Advanced search
1 file | 142.20 KB Add to list

Planned change or emergent change implementation approach and nurses' professional clinical autonomy

(2017) NURSING IN CRITICAL CARE. 22(6). p.372-381
Author
Organization
Abstract
Background: Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. Aims and objectives: To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. Design: Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. Methods: Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. Results: Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. Conclusions: In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. Relevance to clinical practice: If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy.
Keywords
Autonomy, Emergent change, Implementation, Nursing, Planned change, PREOPERATIVE EDUCATION, CLASSIFICATION-SYSTEM, EXPERIENCES, RECOVERY, ANXIETY, APACHE, TRIAL, PAIN

Downloads

  • (...).pdf
    • full text
    • |
    • UGent only
    • |
    • PDF
    • |
    • 142.20 KB

Citation

Please use this url to cite or link to this publication:

MLA
Luiking, Marie-Louise, Leon Aarts, Leo Bras, et al. “Planned Change or Emergent Change Implementation Approach and Nurses’ Professional Clinical Autonomy.” NURSING IN CRITICAL CARE 22.6 (2017): 372–381. Print.
APA
Luiking, M.-L., Aarts, L., Bras, L., Grypdonck, M., & van Linge, R. (2017). Planned change or emergent change implementation approach and nurses’ professional clinical autonomy. NURSING IN CRITICAL CARE, 22(6), 372–381.
Chicago author-date
Luiking, Marie-Louise, Leon Aarts, Leo Bras, Maria Grypdonck, and Roland van Linge. 2017. “Planned Change or Emergent Change Implementation Approach and Nurses’ Professional Clinical Autonomy.” Nursing in Critical Care 22 (6): 372–381.
Chicago author-date (all authors)
Luiking, Marie-Louise, Leon Aarts, Leo Bras, Maria Grypdonck, and Roland van Linge. 2017. “Planned Change or Emergent Change Implementation Approach and Nurses’ Professional Clinical Autonomy.” Nursing in Critical Care 22 (6): 372–381.
Vancouver
1.
Luiking M-L, Aarts L, Bras L, Grypdonck M, van Linge R. Planned change or emergent change implementation approach and nurses’ professional clinical autonomy. NURSING IN CRITICAL CARE. 2017;22(6):372–81.
IEEE
[1]
M.-L. Luiking, L. Aarts, L. Bras, M. Grypdonck, and R. van Linge, “Planned change or emergent change implementation approach and nurses’ professional clinical autonomy,” NURSING IN CRITICAL CARE, vol. 22, no. 6, pp. 372–381, 2017.
@article{8545882,
  abstract     = {Background: Nurses' clinical autonomy is considered important for patients' outcome and influenced by the implementation approach of innovations. Emergent change approach with participation in the implementation process is thought to increase clinical autonomy. Planned change approach without this participation is thought not to increase clinical autonomy. Evidence of these effects on clinical autonomy is however limited. 
Aims and objectives: To examine the changes in clinical autonomy and in personal norms and values for a planned change and emergent change implementation of an innovation, e.g. intensive insulin therapy. 
Design: Prospective comparative study with two geographically separated nurses' teams on one intensive care unit (ICU), randomly assigned to the experimental conditions. 
Methods: Data were collected from March 2008 to January 2009. Pre-existing differences in perception of team and innovation characteristics were excluded using instruments based on the innovation contingency model. The Nursing Activity Scale was used to measure clinical autonomy. The Personal Values and Norms instrument was used to assess orientation towards nursing activities and the Team Learning Processes instrument to assess learning as a team. 
Results: Pre-implementation the measurements did not differ. Post-implementation, clinical autonomy was increased in the emergent change team and decreased in the planned change team. The Personal Values and Norms instrument showed in the emergent change team a decreased hierarchic score and increased developmental and rational scores. In the planned change team the hierarchical and group scores were increased. Learning as a team did not differ between the teams. 
Conclusions: In both teams there was a change in clinical autonomy and orientation towards nursing activities, in line with the experimental conditions. Emergent change implementation resulted in more clinical autonomy than planned change implementation. 
Relevance to clinical practice: If an innovation requires the nurses to make their own clinical decisions, an emergent change implementation should help to establish this clinical autonomy.},
  author       = {Luiking, Marie-Louise and Aarts, Leon and Bras, Leo and Grypdonck, Maria and van Linge, Roland},
  issn         = {1362-1017},
  journal      = {NURSING IN CRITICAL CARE},
  keywords     = {Autonomy,Emergent change,Implementation,Nursing,Planned change,PREOPERATIVE EDUCATION,CLASSIFICATION-SYSTEM,EXPERIENCES,RECOVERY,ANXIETY,APACHE,TRIAL,PAIN},
  language     = {eng},
  number       = {6},
  pages        = {372--381},
  title        = {Planned change or emergent change implementation approach and nurses' professional clinical autonomy},
  url          = {http://dx.doi.org/10.1111/nicc.12135},
  volume       = {22},
  year         = {2017},
}

Altmetric
View in Altmetric
Web of Science
Times cited: